Purpose:
Intravitreal injections of anti-VEGF agents are increasingly common in the management of a number of ophthalmologic conditions and are often administered on a chronic basis. While the potential intraocular risks of this procedure have been well documented and studied, there have not been any definitive studies on the effect of intravitreal injections on the ocular surface. The purpose of this study is to evaluate the association between intravitreal injections of anti-VEGF agents, dry eye symptoms and ocular surface health.

Methods:
This is a prospective study of patients receiving intravitreal injections of Avastin, Lucentis and or Eyelea. Patients are evaluated 2-4 weeks after injection using the Ocular Surface Disease Index (OSDI) for symptoms of dry eye, tear breakup time, fluorescein staining, lissamine green staining, and Schirmer testing. Eyes that received injections are compared with eyes that did not receive injections within the allotted time frame. Patients are also being evaluated 4-6 months after the cessation of intravitreal injections using the above parameters.

Results:
Preliminary results include data from 12 patients. The average OSDI for all eyes which had received an intravitreal injection within 2 weeks to 1 month was 21.91. In patients who received unilateral injections, the average OSDI for injected eyes was 25.36, which was significantly higher than the average OSDI of 4.00 for non-injected eyes (p = 0.002). Fluorescein staining of the cornea was noted more frequently in the injected eye than in the non-injected, specifically in the temporal quadrant (p = 0.017). Lissamine green revealed mild staining of the inferotemporal area in 50% of injected eyes and 25% of non-injected eyes. The average tear break up time (TBUT) was 9.8 for injected eyes and 9.5 for non-injected eyes. Average Schirmer’s basic secretions test values were 14.6 for injected eyes and 15.1 for non-injected eyes.

Conclusions:
Preliminary results may indicate that intravitreal injections of anti-VEGF agents have a significant impact on ocular surface health. This finding is important given the facts that intravtreal injections have become the most commonly billed Medicare procedure in ophthalmology and that dry eye symptoms have been shown to have dramatic implications on quality of life. Symptoms and clinical signs of dry eye following intravitreal injections should be monitored and treated to optimize patient comfort and visual potential.